Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults / 대한족부족관절학회지

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.

Moderating effects of Professional Self-concept in Relationship between Workplace Bullying and Nursing Service Quality among Hospital Nurses / 간호행정학회지

PURPOSE: To identify the effects of workplace bullying of hospital nurses on the quality of nursing service and to investigate the moderating effects of professional self-concept in the relationship between workplace bullying and quality of nursing service. METHODS: The participants in this study were 280 nurses working in hospitals located in J Province. Data were collected from December 20, 2016, to January 20, 2017. A self-administered structured questionnaire was used. Data were analyzed using the SPSS/WIN 22.0 statistical program. RESULTS: Workplace bullying had significant negative correlations with professional self-concept and nursing service quality. There was a significant positive correlation between professional self-concept and nursing service quality. Professional self-concept was the only variable to show a moderating effect in the relationship between the outcome of workplace bullying and quality of nursing service (β=−.12, p=.023). CONCLUSION: The findings from this study suggest building a systematic strategy to prevent workplace bullying at the organizational-level, where it threatens quality of nursing service and developing programs to promote professional self-concept, which can control the negative effect of workplace bullying.

Cultural Competence and Factors Influencing Cultural Competence in Nursing Students / 정신간호학회지

PURPOSE: The purpose of this study was to identify cultural competence and factors influencing cultural competence of nursing students in South Korea. METHODS: Participants in this study were 248 nursing students who agreed to participate in the study. Data were collected during November and December, 2012 using structured questionnaires. Data were analyzed using PASW/WIN 20.0 program and included t-test, one-way ANOVA, Scheffe test, and multiple regression. RESULTS: The mean score for cultural competence in nursing students was 3.0 points out of a possible 5. Factors influencing cultural competence in nursing students were identified as being female (beta=-.23), third year (beta=.30), having foreign friends (beta=.29) and fluency (beta=.12). These factors explained 18% of cultural competence reported by nursing students (F=10.13, p<.001). CONCLUSION: The results of this study show the major factors influencing cultural competence in nursing students. Therefore, it is recommended that further cultural competence promotion programs for nursing students be considered directly along with ongoing transcultural experiences.

The First Korean Case of Disseminated Mycetoma Caused by Nocardia pseudobrasiliensis in a Patient on Long-Term Corticosteroid Therapy for the Treatment of Microscopic Polyangiitis

Nocardia pseudobrasiliensis is predominantly associated with invasive infections in immunocompromised patients. We report a case of disseminated mycetoma caused by N. pseudobrasiliensis in a 57-yr-old woman with microscopic polyangiitis, who was treated for 3 months with corticosteroids. The same organism was isolated from mycetoma cultures on the patient's scalp, right arm, and right leg. The phenotypic characteristics of the isolate were consistent with both Nocardia brasiliensis and N. pseudobrasiliensis, i.e., catalase and urease positivity, hydrolysis of esculin, gelatin, casein, hypoxanthine, and tyrosine, but no hydrolysis of xanthine. The isolate was identified as N. pseudobrasiliensis based on 16S rRNA and hsp65 gene sequencing. The patient was treated for 5 days with intravenous ampicillin/sulbactam, at which time both the mycetomas and fever had subsided and discharged on amoxicillin/clavulanate. This case highlights a very rare presentation of mainly cutaneous mycetoma caused by N. pseudobrasiliensis. This is the first reported case of N. pseudobrasiliensis infection in Korea.

The First Korean Case of Disseminated Mycetoma Caused by Nocardia pseudobrasiliensis in a Patient on Long-Term Corticosteroid Therapy for the Treatment of Microscopic Polyangiitis

Nocardia pseudobrasiliensis is predominantly associated with invasive infections in immunocompromised patients. We report a case of disseminated mycetoma caused by N. pseudobrasiliensis in a 57-yr-old woman with microscopic polyangiitis, who was treated for 3 months with corticosteroids. The same organism was isolated from mycetoma cultures on the patient's scalp, right arm, and right leg. The phenotypic characteristics of the isolate were consistent with both Nocardia brasiliensis and N. pseudobrasiliensis, i.e., catalase and urease positivity, hydrolysis of esculin, gelatin, casein, hypoxanthine, and tyrosine, but no hydrolysis of xanthine. The isolate was identified as N. pseudobrasiliensis based on 16S rRNA and hsp65 gene sequencing. The patient was treated for 5 days with intravenous ampicillin/sulbactam, at which time both the mycetomas and fever had subsided and discharged on amoxicillin/clavulanate. This case highlights a very rare presentation of mainly cutaneous mycetoma caused by N. pseudobrasiliensis. This is the first reported case of N. pseudobrasiliensis infection in Korea.

The Paradigm Model of VIP Ward Nurses' Decision Making / 산업간호학회지

PURPOSE: The purpose of this research was to describe the decision making of nurses in a VIP ward. METHOD: The methodology of collecting and analyzing the data was based on the grounded theory of Strauss and Corbin (1998). The data were collected through an in-depth interview, which were audio-taped and transcribed. The data were collected from 10 nurses from July to November 2007. RESULTS: The core category on VIP ward nurses' decision making was named as "adjusting with flexibility and deepened insight." The causal condition was established by 'the patients who wanted to be treated specially.' The contextual conditions included 'caring patients from various departments,' 'differences depending on the nurses' clinical experience,' and 'client-centered atmosphere in the VIP ward.' The intervening conditions included 'problem solving styles of nurses', 'attitudes of patients and family members', 'nurse-doctor relationships', and 'accessibility to information.' It was confirmed that nurses changed their action-interaction strategies depending on the intervening conditions, thus resulted in the nurses' role conflict and the need to expand their consciousness. CONCLUSION: The result of this study indicates that nurse's decision making depends on their experiences and the nature of social context in which nursing occurs.

Transcriptional profiling in human HaCaT keratinocytes in response to kaempferol and identification of potential transcription factors for regulating differential gene expression

Kaempferol is the major flavonol in green tea and exhibits many biomedically useful properties such as antioxidative, cytoprotective and anti-apoptotic activities. To elucidate its effects on the skin, we investigated the transcriptional profiles of kaempferol-treated HaCaT cells using cDNA microarray analysis and identified 147 transcripts that exhibited significant changes in expression. Of these, 18 were up-regulated and 129 were down-regulated. These transcripts were then classified into 12 categories according to their functional roles: cell adhesion/cytoskeleton, cell cycle, redox homeostasis, immune/defense responses, metabolism, protein biosynthesis/modification, intracellular transport, RNA processing, DNA modification/ replication, regulation of transcription, signal transduction and transport. We then analyzed the promoter sequences of differentially-regulated genes and identified over-represented regulatory sites and candidate transcription factors (TFs) for gene regulation by kaempferol. These included c-REL, SAP-1, Ahr-ARNT, Nrf-2, Elk-1, SPI-B, NF-kappaB and p65. In addition, we validated the microarray results and promoter analyses using conventional methods such as real-time PCR and ELISA-based transcription factor assay. Our microarray analysis has provided useful information for determining the genetic regulatory network affected by kaempferol, and this approach will be useful for elucidating gene-phytochemical interactions.

Cytogenetic study in 14,402 patients referred for suspected congenital disorders in Korea: YUMC 31 years experience from 1974 to 2004 years / 대한산부인과학회지

OBJECTIVE: To make a guideline for cytogenetic study and diagnosis through systematic analysis of types and the incidences of chromosomal abnormalities obtained from various types of congenital disorder in Korea. METHODS: The cytogenetic study was performed on 14,402 patients with suspected chromosomal abnormalities at our genetic laboratory of the medical research center between January 1, 1974 to December 31, 2004 and additionally the FISH (Fluorescence in situ hybridization) study was done on 272 patients between January 1, 1998 to December 31, 2004. RESULTS: Total number of case requiring cytogenetic study were 33 in starting year (1974) and by 1983, the number increased rapidly to 481 cases. The number of case was maximum of 894 cases in 1993 and it started to decline from 1996 to 714. Overall chromosomal aberrations were 2,100 cases (14.58%). Autosomal chromosomal abnormalities were 1,257 cases (8.73%). Among those cases, Down syndrome was 848 cases (5.89%), Edward syndrome was 38 cases (0.26%), and Patau syndrome was 6 cases (0.04%) in order of frequency. Sex chromosomal abnormalities were 843 cases (5.85%) in total. Among those cases, Turner syndrome was 527 cases (3.66%), Kleinfelter syndrome was 267 cases (1.85%). Chromosomal abnormality rate in 535 couples with recurrent spontaneous abortions was 5.98% (32 couples). And chromosomal aberration in 1068 cases with primary amenorrhea was 63.95% (683 cases). The diagnostic rate of microdeletion syndrome by FISH method was 22.71%, and marker chromosome was 20.56%. CONCLUSION: From cytogenetic analysis of 14,402 cases performed in single institute during 31 years, we performed a study on the types and the incidences of chromosomal abnormalities. We hope we could suggest a guideline for studies and treatments of congenital disorders in Korea. Along with the cytogenetic study, FISH study was also required.

Turnover Experience of Hospital Nurses in Korea / 성인간호학회지

PURPOSE: The purpose of the study was to explore how hospital nurses decide to quit working as professional nurses using the grounded theory method. METHOD: The data was collected by individual in-depth interviews with 12 hospital nurses who recently resigned from work and it was analyzed using 'constant comparative analysis.' RESULT: The core category that emerged was "in search of new balance with self, work, and family". Three stages were identified: 1) "unconditionally accepting the working situation of itself," 2) "weighing advantages and disadvantages of working as a hospital nurse", and 3) "redesigning a future". Each stage contains three major strategies. The major strategies of the first stage are "maintaining a learning attitude", "enduring physical burnout," and "enduring unfair interpersonal relationships". The second stage contains "identifying advantages of working", "identifying disadvantages of working", and "comparing the advantages with the disadvantages". Lastly, the third stage includes "reassessing the aim of life", "beginning to construct an alternative life", and "deciding to quit working at a certain point". CONCLUSION: The results of the study will help nursing administrators in designing and implementing an effective turnover prevention program for nurses by understanding more deeply the process of turnover phenomenon among hospital nurses.

Trichosporon Species in Onychomycosis and Tinea Pedis / 대한피부과학회지

BACKGROUND: Onychomycosis and tinea pedis are common superficial fungal infections. Causative organism in onychomycosis and tinea pedis have been extensively studied, but the pathogenic role of non-dermatophyte is still controversial. Trichosporon species are soil and water-inhabiting yeasts, and occasionally found in the normal flora of human skin, mouth, and nails. Trichosporon spp. have been reported to be one of the pathogens in onychomycosis and tinea pedis. OBJECTIVE: We performed mycologic studies to investigate the prevalence and significance of trichosporon spp. in skin and nail lesions, which were clinically suspected of onychomycosis and tinea pedis. METHOD: We performed a survey of the mycologic laboratory records of patients clinically suspected of onychomycosis and tinea pedis from August 2001 to July 2002, and tried to identify trichosporon to species level by using API 20C kit systems. RESULTS: Out of total 1509 nail and skin samples examined, 663(43.9%) were culture positive. Trichosporon spp. were recovered from 11.2%(74/663) of the samples. In onychomycosis considered alone, the prevalence of solitary isolated Trichosporon spp. was 7.7%. In species level, T. asahii(62.1%), T. mucoides(20.3%), and T. inkin(14.9%) were isolated in decreasing frequency. The positive rate for KOH examination in trichosporon spp. was 52.9%. Among the isolated trichosporon spp., mixed cultures with other organisms were 13(17.6%) and solitary isolates were 61(82.4%). 31(41.9%) were not only positive for KOH examination but also founded in pure culture in relatively large colony counts. In pure culture isolations, high colony counts predominated over mixed cultures. CONCLUSION: Trichosporon spp. is a relatively common isolates from fungal cultures of skin and nail, and it may be pathogenic in some cases of skin or nail infection.

A Case of Stomatococcus mucilaginosus Septicemia in a Neutropenic Patient / 대한임상병리학회지

Stomatococcus mucilaginosus is a Gram-positive coccus normally found in the oropharynx and upper respiratory tract. Recently, S. mucilaginosus has been increasingly reported to cause seri-ous infections in immunocompromised patients. A 42-year-old male patient with chronic myeloge-nous leukemia developed the clinical signs and symptoms of septicemia in the state of neutropenia due to the failure of a bone marrow transplant. The blood cultures revealed Gram-positive cocci in three sets of aerobic blood culture bottles. The bacteria were identified as S. mucilaginosus by an API STAPH Identification Panel (bioMerieux SA, Marcy 1 'Etoile, France). The patient was cured bacteriologically with a vancomycin treatment for 20 days. Here we report the first case of S. mucilaginosus septicemia in Korea.

A Case of Fixed Cutaneous Type Sporotrichosis with Many Fungal Elements on Histopathologic Examination / 대한피부과학회지

We report a case of fixed cutaneous type sporotrichosis with atypical histopathologic findings in a 18-year-old male patient, who presented with a 1-year history of a 4x3 cm sized, crusted, erythematous plaque and several small erythematous papules on the left knee. The histopathologic findings showed pseudoepitheliomatous hyperplasia, abscess formation, chronic granulomatous inflammation and many PAS-positive fungal spores and hyphae in the dermis. Sporothrix schenckii was identified with fungal culture of biopsy specimen. The lesions improved with three pulses of itraconazole 400mg daily for a week per month.

A Case of Toenail Onychomycosis Caused by Trichosporon asahii / 대한피부과학회지

We report the first case of toenail onychomycosis caused by Trichosporon asahii in a 60-year old Korean man. The patient presented with a typical distal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide(KOH) preparation revealed fungal elements. On modified dermatophyte agar, the colony was white color and wrinkled, folded with furrows and convolutions and microscopic morphology showed long rectangular arthroconidia and lateral blastoconidia of trichosporon species. The fungus was identified as T. asahii using API 20C AUX (bioMerieux S.A., l'Etolile, France) kit.

Evaluation of MicroScan Neg Combo Panel type 21 to Detect ESBL / 대한임상미생물학회지

BACKGROUND: Escherichia coli and Klebsiella pneumoniae resistant to 3rd generation cephalosporin have been reported with increasing frequency in tertiary-care hospital in Korea. MicroScan Neg Combo Panel Type 21 (Type 21) contains a 1 microgram/mL cepfodoxime (POD) in addition to other screen wells containing ceftazidime, cefotaxime, ceftriaxone, and aztreonam, which are designed for detecting extended-spectrum beta-lactamase (ESBL)-producing E. coli and Klebsiella species. We evaluated the Type 21 panel for its ability to detect ESBL. METHODS: From November to December in 1998, 496 E. coli and 326 K. pneumoniae strains isolated from clinical specimens were tested with Type 21 panel The isolates flagged as ESBL producers by the panel were confirmed by the double disk synergy test (DDS). To evaluate the specificity of POD, n-lactamases of 54 E, coli and 20 K. pneumoniae strains that were flagged by, POD only from January to May 1999 were analyzed by isoelectric focusing(IEF). RESULTS: 75/496(15%) E. coli and 68/326(21%) K. pneumoniae were flagged as ESBL producers by Type 21 panel. Of those, 94 isolates including 38/75 (51%) of E. coli and 56/68 (82%) of K. pneumoniae were positive for DDS. Among the 94 ESBL producers, all were detected by POD, 84% by cefotaxime, 85% by ceftazidime, 84% by ceftriaxone, and 86% by aztreonam. The 74 strains that were flagged as ESBL producers by POD screen well only were mostly DDS-negative, cefoxitin- resistant and showed beta-lactamases with pls of 5.4 and 7.6 or no band, which could be interpreted as the presence of TEM-1 or SHV-1 type beta-lactamases and/or basal AmpC beta-lactamases, not ESBL. CONCLUSION: MicroScan Neg Combo Panel Type 21 was able to detect a greater number of ESBL producers by inclusion of POD in its screening well. However, the specificity of POD was compromised by flagging a significant number of DDS negative strains. We conclude that the isolates with reduced susceptibility to 3rd generation cephalosporins as well as POD can be reported as ESBL-producers and those resistant to POD only should be confirmed by DDS.

A Case of Malignant Chondroid Syringoma with Lung Metastasis / 대한암학회지

Malignant chondroid syringoma, previously called "mixed tumor of the skin of the salivary gland type"is a fairly uncommon type of sweat gland tumor. Malignant chondroid syringoma frequently arises from the trunk and extremities, whereas the benign tumor is common to the head region. The present case occurred in a female. The malignant nature of the tumor was evident from repeated recurrences after excision of the mass and histopathological study. Lack of response to radiotherapy and chemotherapy led to widespread metastasis. We report a case of malignant chondroid syringoma with lung metastasis in a 39-year-old female patient and response to chemotherapy. We also reviewed the literatures of malignant chondroid syringoma.

Asan Medical Center Laboratory Information System(VI): Information Communication System for Routine Urinalysis Using a Down-Sized Computer / 대한의료정보학회지

Laboratory information system(LIS) is a key tool for management of laboratory data and for improvement of service quality in clinical pathology. Using down-sized computer system, we have developed an information management system, for urinalysis. The hardware is organized with an IBM 486 compatible PC with 16 MB main memory, 210 MB hard disk drive, three terminals, and 24 pin dot printer. The system is interfaced with one automatic urine analyzer(Miditron-M) via RS-232C port for unidirectional data transmission form analyzer to computer. The operating system and database management system are SCO UNIX and SCO foxbase, respectively. The program was developed using Xbase language provided by SCO foxbase and C language for interface. The system is connected to our hospital information system via application program interface(API), so the informations about patients and request details are automatically transmitted to our computer. Pull-down menu makes the users to access system more easily and the urinalysis results obtaining through interface can be reviewed during microscopic examination by users. To reduce workload, the default value was assigned to urine color, turbidity and cell count. To minimize the individual difference and standardize interpretation criteria, the recording results were entered as a code originating from objective grading system. The authors suggest that this system based on down-sized computer could provide a progressive approach to total LIS based on local area network, and the implemented system could serve as a model for constructing LIS in other hospitals for routine urinalysis.

Long Term Respiratory Management in the Patients with Respiratory Pump Failure / 대한마취과학회지

Respiratory pump failure is a condition which the respiratory system can not meet the metabolic demand because of the inability of respiratory muscles to ventilate the lungs without any pulmonary pathology. Two cases of respiratory pump failure(myasthenia gravis and Guillian-Barre syndrome) had been treated with controlled and assisted ventilation using the Bennet MA II ventilator. Large tidal volume with high peak flow rate was given to permit leakage of gases during inspiration when the patients were ventilated with CMV with asaistance. This made the patients capable of communicating with persons by phonation which was the greatest advanage of this mode of assisted ventilation.

Induction of Anesthesia for Cesarean Section Using Small Dose of Ketamine / 대한마취과학회지

Safety for both mother and infant is an imperative element in anesthesia for cesarean section, and ketamine has been widely used in obstetrical anesthesia especially for analgesis for normal vagianl delivery. Small doses of ketamins(0.2~0.5mg/kg) provides satisfactory analgesia during delivery without significant marternal and fetal complications. We added nitrous oxide to the small dose of ketamine and applied it to the induction of anesthesia for cesarean section and the results were compared with those of thiopental. A small dose of ketamine with nitrous oxide may be superior to an ordinary dose of thiopental, in the effects on the maternal cardiovascular system and the Apgar score of the fetus although the Apgar score only is not sufficient to evaluate neonatal condition.